Safety Steps for Epidural Injection of Local Anesthetics

Mulroy, Michael F.; Norris, Mark C.; Liu, Spencer S.

doi:10.1097/00000539-199712000-00030

Cited by 59 publications

(29 citation statements)

References 75 publications

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“…It is widely recommended, especially before the administration of large doses of local anaesthetic. 2,28 Although not infallible in identifying a spinally placed catheter, 12,14,18 its reliability for detecting intravenous placement of multiple orifice epidural catheters has been favourably compared with the epinephrine test. 15,29 The Ôair test' has been proposed as a method of identifying intravenous placement 30 but is rarely used in the UK.…”

Section: Non-pharmacological Testsmentioning

confidence: 99%

“…13 Respondents stating that they assess the effect of the test dose at multiple time points are probably "seeking multiple signs and symptoms that suggest spinal drug injection." 28 Epinephrine produces a transient response that requires careful monitoring to detect. Epinephrine should give a positive response within 2 min if the catheter is intravenous 1 and the changes will have reversed by 5 min.…”

Section: Assessment and Effects Of The Test Dosementioning

confidence: 99%

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Obstetric epidural test doses: a survey of UK practice

Gardner

Kinsella

2005

International Journal of Obstetric Anesthesia

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Section: Non-pharmacological Testsmentioning

confidence: 99%

Section: Assessment and Effects Of The Test Dosementioning

confidence: 99%

Obstetric epidural test doses: a survey of UK practice

Gardner

Kinsella

2005

International Journal of Obstetric Anesthesia

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“…kardiovaskulären Intoxikationen,falls Lokalanästhetika versehentlich intravasal injiziert werden,falls inadäquat hohe Dosen verwendet werden bzw. falls die Substanzen unerwartet schnell am Injektionsort resorbiert werden.Aus diesem Grunde werden eine Reihe von grundlegenden Sicherheitsmaß-nahmen empfohlen, um diese sehr seltenen,dann aber meist katastrophalen Zwischenfälle zu vermeiden [156]: Unabhän-gig von der angewandten Technik dürfen sämtliche Lokalanästhetika nur sehr langsam und fraktioniert injiziert werden; hierbei kann durch wiederholtes Aspirieren die intravasale Applikation vermieden werden [158]. Die gleichzeitige Gabe von "Markersubstanzen", die sofort eine versehentliche intravenöse bzw.-arterielle Injektion, z.…”

Section: Therapieoptionen Bei Systemischer Intoxikationunclassified

Toxikologie der Lokalan�sthetika

Zink

Graf

2003

Der Anaesthesist

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Regardless of their specific physico-chemical properties and chemical structures, all local anaesthetic agents block neuronal voltage-gated sodium channels, and thus suppress conduction in peripheral nerves. Since these ion channels ubiquitously appear in excitable membranes, systemic accumulation of local anaesthetic agents may affect the functional integrity of these structures. Clinically, local anaesthetic-induced systemic toxicity results in central nervous and cardiovascular malfunction. With regard to CNS toxicity, symptoms which are largely drug-independent appear in a characteristic biphasic sequence. Nevertheless, the plasma levels necessary to provoke these symptoms are to a large extent agent-specific. Initially, these toxic mechanisms are due to a selective blockade of cortical inhibitory neurons, which enables the formation of seizure potentials within subcortical structures. With high cerebral drug levels, however, excitatory neurons are also increasingly blocked, resulting in coma, apnoeic episodes and circulatory failure. Direct cardiac effects of local anaesthetics can be divided into (i) stereospecific inhibition of intracardial conduction and (ii) unspecific inhibition of myocardial energy supply and ion channels. The corresponding spectrum of symptoms is not uniform and may range from extreme bradycardia, (malignant) ventricular arrhythmia to refractory cardiac arrest. Local tissue toxicity has to be strictly delimited from systemic toxicity and allergies, respectively, which are mainly caused by aminoester agents. Local anaesthetics may cause neuronal and striated muscle injury at the site of injection. With regard to (central) neurotoxicity, "transient neurologic symptoms" and "cauda equina syndrome" have been increasingly recognised. However, the clinical relevance of local anaesthetic-induced myotoxicity is still controversly discussed. In order to avoid systemic accumulation of local anaesthetic agents, several safety procedures have to be considered during the application of these drugs. The treatment of systemic toxicity is strictly dependent on the expression of symptoms. However, hypoxia and acidotic episodes must be avoided and must be treated aggressively.

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“…The incidence of injuries involving the epidural venous plexus on intravascular (IV) epidural catheter insertion was between 1.3% and 15.7% for obstetric patients; the incidence was higher when the puncture is performed with the patients in the sitting position [2]. Furthermore, inadvertent epidural venous injuries may lead to local anesthetic-induced cardio-or neurotoxicity, a poor anesthetic effect, and even the occurrence of epidural hematomas [8][9][10]. Therefore, it is important to make an effort to prevent blood vessel injuries during obstetric epidural anesthesia.…”

Section: Introductionmentioning

confidence: 99%